Heartburn
Heartburn is a common condition characterized by a burning sensation in the chest, often occurring shortly after eating. This discomfort arises when stomach acid flows back into the esophagus due to a malfunction of the lower esophageal sphincter (LES), which is a muscle that normally keeps the stomach's contents contained. Symptoms typically manifest about thirty minutes to one hour post-meal and may include a sour taste in the mouth, sore throat, or dry cough. While heartburn can be uncomfortable, it is important to differentiate it from potentially serious conditions like heart attacks, as the two can present similar chest pain, particularly in emergency situations.
To manage heartburn, individuals are often advised to modify dietary and lifestyle habits, avoiding triggers such as tobacco, alcohol, and certain foods that can weaken the LES. Over-the-counter antacids and medications that reduce acid production are available for occasional relief. For more persistent cases, further investigation may be necessary to rule out serious underlying health issues. In some instances, surgical options exist to strengthen the LES, though ongoing medication may still be required afterward. Understanding these aspects of heartburn can help those affected seek appropriate treatment and lifestyle adjustments.
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Subject Terms
Heartburn
Also known as: Acid indigestion
Anatomy or system affected: Chest, gastrointestinal system, throat
Definition: A feeling of warmth or discomfort in the chest
Causes and Symptoms
Heartburn occurs when acid travels backward from the stomach to the esophagus. Acid is normally present at very high concentrations in the stomach, where it aids digestion. Contrary to popular belief, most people who suffer from heartburn do not produce too much acid. Rather, they have a malfunction of the lower esophageal sphincter (LES), a ring of muscle between the stomach and the esophagus. Normally, unless food is being swallowed, the LES stays closed. This keeps acid confined to the stomach. If the LES remains open, or if it is weakened, then stomach acid can travel freely to the esophagus and irritate its inner lining, resulting in heartburn.
Heartburn is described as a hot, burning feeling in the chest. It usually occurs thirty minutes to one hour after eating and lasts for several minutes. It is often worsened by lying down or bending over and is improved by standing up. Other associated symptoms may include a sour taste in the mouth, sore throat, or hoarseness. Some patients develop a dry cough as a result of acid irritating the throat. Heartburn must be distinguished from more ominous causes of chest pain, including a heart attack or other heart-related chest pain. These two types of pain can feel so similar that many patients arrive to the emergency room thinking they are experiencing a cardiac event when they are suffering from heartburn. Usually, chest pain attributable to such causes becomes worse with exertion, while heartburn should not. Some cases of heartburn may also be caused by the condition known as Barrett's esophagus.
Treatment and Therapy
The initial therapy for heartburn includes elimination of dietary and lifestyle factors that weaken the LES: tobacco, excessive alcohol, fatty foods, chocolate, and caffeine. Medications such as calcium-channel blockers and nitrates can also worsen heartburn, but they should not be discontinued without consulting a physician. It has been suggested that avoiding late-night meals and elevating the head of the bed with blocks underneath the headboard can improve heartburn, especially if symptoms occur mostly at nighttime. Occasional heartburn can be treated with over-the-counter antacids or medications such as ranitidine, which reduces acid production. If symptoms do not improve, then prescription medications are also available.
Surgery to reinforce the LES called a Nissen fundoplication, is another option. Although the results are excellent, patients often must take acid-suppressive medications after the procedure. Heartburn that is persistent or accompanied by trouble swallowing, weight loss, or bleeding requires a more thorough investigation, as with endoscopy, to exclude the possibility of cancer or another serious medical condition.
Bibliography
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